MARCH 19TH

POOR RICHARD'S ALMANACK

Sorrow is dry.

— Benjamin Franklin,1743

AMERICANREVOLUTION.ORG

CHAP. I.Of SUTURES.

WHEN a Wound is recent, and the Parts of it
are divided by a sharp Instrument, without any farther Violence,
and in such a manner that they may be made to approach each other,
by being returned with the Hands they will, if held in close
Contact for some Time, reunite by Inoculation, and cement like
one Branch of a Tree ingrafted on another. To maintain them in
this Situation, several sorts of Sutures have been invented,
and formerly practised, but the Number of them has of late been
very much reduced. Those now chiefly described, are the interrupted,
the Glover's, the quilled, the twisted, and the dry Sutures;
but the interrupted and twisted, are almost the only useful one's;
for the quilled Suture is never preferable to the interrupted;
the dry Suture is ridiculous in terms, since it is only a Piece
of Plaister applied in many different Ways to re-unite the Lips
of a Wound; and the Glover's, or uninterrupted Stitch, which
is advised in superficial Wounds, to prevent the Deformity of
a Scar, does rather, by the Frequency of the Stitches, occasion
it, and is therefore to be rejected in favour of a compress and
sticking Plaister; the only Instance where I would recommend
it, is in a Wound of the Intestine: the Manner of making this
Suture I shall describe in the Chapter of Gastroraphy.

From the Description I have given of the State
of a Wound proper to be sewed up, it may be readily conceived,
that Wounds are not fit Subjects for Suture, when there is either
a Contusion, Laceration, Loss of Substance, great Inflammation,
Difficulty of bringing the Lips into Apposition, or some extraneous
Body insinuated into them; tho' sometimes a lacerated Wound may
be assisted with one or two Stitches. It has formerly been forbidden
to sew up Wounds of the Head; but this Precaution is very little
regarded by the Moderns; though the ill Effects I have frequently
seen from Matter pent up under the Scalp, and the great Convenience
there is of using Bandage on the Head, have convinced me, that
much less Harm would be done, if Sutures were used in this Part
with more Caution.

If we stitch up a Wound that has none of these
Obstacles, we always employ the interrupted Suture, passing the
Needle two, three, or four Times in Proportion to the Length
of it, though there can seldom be more than three Stitches required.

The Method of doing it is this: the Wound
being emptied of the grumous Blood, and your Assistant having
brought the Lips of it together, that they may lie quite even;
you carefully carry your Needle from without, inwards to the
Bottom, and so on from within, outwards; using the Caution of
making the Puncture far enough from the Edge of the Wound, which
will not only facilitate the passing the Ligature, but will also
prevent it from eating through the Skin and Flesh; this Distance
may be three or four tenths of an Inch: as many more Stitches
as you shall make, will be only Repetitions of the same Process.
The Threads being all passed, you begin tying them in the Middle
of the Wound, though if the Lips are held carefully together
all the while, as they should be, it will be of no great Consequencewhich is done first. The most useful Kind of
Knot in large Wounds, is a single one first, over this, a little
Linnen Compress, on which is to be made another single Knot,
and then a Slip-knot, which may be loosened upon any Inflammation;
but in small Wounds, there is no Danger from the double Knot
alone, without any Compress to tie it upon; and this is most
generally practised. If a violent Inflammation should succeed,
loosening the Ligature only will not suffice; it must be cut
through and drawn away, and the Wound be treated afterwards without
any Suture. When the Wound is small, the less it is disturbed
by dressing, the better; but in large ones, there will sometimes
be a considerable Discharge, and if the Threads be not cautiously
carried through the Bottom of it, Abscesses will frequently ensue
from the Matter being pent up underneath and not finding Issue.
If no Accident happen, you must, after the Lips are firmly agglutinated,
take away the Ligatures, and dress the Orifices which they leave.

It must be remembered, that during the Cure,
the Suture must be always assisted by the Application of Bandage,
if possible, which is frequently of the greatest Importance;
and that sort of Bandage with two Heads, and a slit in the Middle,
which is by much the best, will in most Cases be found practicable.
The twisted Suture being principally employed in the Hare-lip,
I shall reserve its Description for the Chapter on that Head.